Bagley Sarah Mary, Wachman Elisha M, Holland Erica, Brogly Susan B
Section of General Internal Medicine, Boston University School of Medicine, 801 Mass Ave, 2nd Floor, Boston, MA 02118, USA.
Addict Sci Clin Pract. 2014 Sep 9;9(1):19. doi: 10.1186/1940-0640-9-19.
Neonatal abstinence syndrome (NAS) secondary to in-utero opioid exposure is an increasing problem. Variability in assessment and treatment of NAS has been attributed to the lack of high-quality evidence to guide management of exposed neonates. This systematic review examines available evidence for NAS assessment tools, nonpharmacologic interventions, and pharmacologic management of opioid-exposed infants. There is limited data on the inter-observer reliability of NAS assessment tools due to lack of a standardized approach. In addition, most scales were developed prior to the prevalent use of prescribed prenatal concomitant medications, which can complicate NAS assessment. Nonpharmacologic interventions, particularly breastfeeding, may decrease NAS severity. Opioid medications such as morphine or methadone are recommended as first-line therapy, with phenobarbital or clonidine as second-line adjunctive therapy. Further research is needed to determine best practices for assessment, nonpharmacologic intervention, and pharmacologic management of infants with NAS in order to improve outcomes.
因子宫内阿片类药物暴露所致的新生儿戒断综合征（NAS）是一个日益严重的问题。NAS评估和治疗的差异归因于缺乏高质量证据来指导对暴露新生儿的管理。本系统评价审视了有关NAS评估工具、非药物干预措施以及阿片类药物暴露婴儿药物治疗管理的现有证据。由于缺乏标准化方法，NAS评估工具的观察者间可靠性数据有限。此外，大多数量表是在普遍使用处方产前伴随药物之前制定的，这可能会使NAS评估复杂化。非药物干预措施，尤其是母乳喂养，可能会降低NAS的严重程度。推荐使用吗啡或美沙酮等阿片类药物作为一线治疗，苯巴比妥或可乐定作为二线辅助治疗。需要进一步研究以确定NAS婴儿评估、非药物干预和药物治疗管理的最佳实践，以改善治疗结果。
